Methods

GoWoman was developed using a community-based participatory research approach, which emphasizes the involvement of community members in the development of all aspects of the program. The project’s five Community Advisory Board members are women with long-term mobility impairment from diverse cultural backgrounds, living in different areas of the country. CAB members assisted in developing the weight loss intervention, providing insight on its appropriateness for women with mobility impairment. They reviewed each session and suggested modifications where necessary. CAB members then participated in a condensed version of the program in the Second Life environment, making suggestions along the way that were incorporated in the program until we were left with the final GoWoman program.

GoWoman is an adaptation of the Lifestyle Change Program component of the Diabetes Prevention Program, which covers topics related to developing strategies and setting goals for increasing physical activity and the consumption of a healthy diet. Although a model for GoWoman’s curriculum, the Diabetes Prevention Program is not designed to address the needs of women with mobility impairment in weight management. GoWoman’s modification to the original content includes strategies that directly address the disability-related factors that affect diet, physical activity, and weight management.

While group settings are effective in weight management programs, in person group meetings may not be widely accessible for women with mobility impairment due to numerous and varied physical and social barriers. Therefore, GoWoman is set in the free online virtual world, Second Life. Meetings in the virtual world will allow participants to access nutrition information and gain social support, self-confidence, and motivation for healthy life changes without the barriers associated with more traditional methods.

Women who meet the following criteria are eligible for GoWoman’s beta and pilot tests.

Inclusion criteria:

• Self-reported, chronic mobility impairment
• At lease one-year with mobility impairment
• BMI between 27 and 40
• Intention to lose weight
• At least 18 years of age
• Medical clearance to participate in the study
• Access to telephone, email, and high speed Internet connections with appropriate graphics card

GoWoman may not be the right program for women with one or more of the following characteristics.

Exclusion criteria:

• Pregnant or lactating, planning to become pregnant, or become pregnant during the program
• Type I or Type II diabetes
• High, untreated blood pressure
• Fail to obtain physician’s authorization to participate in the study
• Self-report pressure ulcer of stage 1 or greater
• Use of supplemental total parenteral nutrition or percutaneous endoscopic gastrostomy tubes
• Having experienced weight loss of greater than 10 pounds in the last three months prior to screening
• Participation in an weight loss study
• Present at screening with psychotic symptoms, active alcohol or drug abuse, and/or score >19 and/or positively endorse the suicide question on the Beck Depression Inventory-II
• Difficulties understanding written and spoken English and/or have cognitive or sensory limitation making it difficult to give informed consent, complete questionnaires, and/or participate in group discussion
• Plan to relocate outside of the Houston metropolitan area or have travel plans that do not permit full participation in the study

Women from the Community Advisory Board beta-tested the program in a two-long condensed version. Their aim was to examine the program’s smoothness of navigation, logical flow of information, and the interactivity and engagement of participants with the website and Second Life.

The pilot test will occur in three waves, each with 10 participants. Just as the CAB members provided feedback in the beta test, pilot test participants will submit surveys at the end of session to provide feedback on the program and provide suggestions for improvement.

Participants will be tracked for:

• Attendance in the program’s 16 sessions
• Completion of homework assignments
• Submission of weekly self-monitoring records for food intake, physical activity, and weight and/or waist circumference using MyFitnessPal
• Self-reported contact with other participants outside of weekly Second Life sessions

Participants are informed that their participation will be tracked. Participation will be rewarded with small monetary prizes and incentives at different points in the program.

GoWoman’s findings will be published not only in the form of academic articles, but also in publically accessible online material, including:

• Instructional and motivational podcasts and lectures from CAB members posted on the website and attached to kiosks on the GoWoman island in Second Life
• Lectures presented in PowerPoint slides with voiceover and captioning from project team members
• Quarterly CROWD e-newsletter